Answer this question truthfully
### Question: Why and when should a breast examination be performed?
### Response: The asymptomatic breast exam is generally performed only on women. This is because diseases of the breast, in particular cancer, occur far more commonly in women then men. Malignancies generally originate in either the glandular tissues that secrete milk or in the ductal structures that transport it to the nipple.
Examination can be done by the clinician (Clinical Breast Exam - CBE) or patient (Self Breast Exam - SBE). Those performed by the clinician are usually done on an annual basis, beginning at the age of 40, which coincides with time of increased risk for development of breast cancer. Other major breast cancer risk factors include: prior history of breast ca, family history in 1st degree relative (particularly if at a young age), increasing patient age and features that result in prolonged/uninterrupted exposure to estrogen (e.g. early age at onset menstruation, never having been pregnant, older age at first pregnancy, older age at menopause). SBE is often recommended on a monthly-to-every-few-months basis.
Interestingly, while both SBE and CBE are part of routine clinical care, there are no studies that demonstrate that either of these techniques, when performed as stand-alone examinations, actually improves clinical outcomes (i.e. detects cancer at an earlier stage, demonstrating positive impact on cancer related morbidity or mortality). In contrast, mammography (performed with or without CBE), has a strong body of evidence to support its routine use as a screening tool for early detection of malignancy.
The goal of the examination in the setting of symptoms is to better characterize the abnormality, identify underlying etiology, and direct additional evaluation and treatment. Breast related symptoms may include any of the following:
Discrete masses detected by the patient, often concerning for malignancy Pain, which can be associated with a number of processes including: cyclical in a menstruating women (reflecting transient hormone induced changes in the breast tissue), occasionally malignancies. Unusual nipple discharge, which may include:
Blood, concerning for malignancy Milk when not pregnant. Suggestive inappropriate Prolactin secretion from the pituitary - may also be induced by certain medications Other
Discoloration or change in the quality of the skin:
Redness suggests infection or inflammation - in the post partum patient, this is often due to mastitis, a diffuse inflammatory condition caused by congestion from inadequately expressed milk. "Peau d'orange" quality - an "Orange Peel" like texture that's caused by an uncommon, aggressive inflammatory malignancy
If a mass or other abnormality is identified, it's location can be described as being in one of 4 quadrants (left upper, left lower, right upper, right lower) of the breast. Alternatively, it can be described relative to it's position, imagining a clock face were superimposed on the breast.
It's worth noting that breast symptoms may be caused by diseases elsewhere in the body. For example, as mentioned above, inappropriate milk production may be due to a pituitary tumor secreting Prolactin. Or breast development in men may signify underlying liver disease. Given this, breast symptoms may merit careful history and evaluation of other organ systems. As symptoms can occur in male or female patients (though overall, female >>> male), evaluation is indicated in either sex patient who presents with breast concerns.